Abstract

Background. Retinol-binding protein-4 (RBP-4) may increase insulin resistance (IR) in animals, with elevated levels reported in humans with obesity and type 2 diabetes. There are, however, few data on concentrations of RBP-4 in gestational diabetes mellitus (GDM).

Methods. We measured fasting serum levels of RBP-4, soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in 50 women at 28 weeks of gestation, divided according to the results of a 50g glucose challenge test (GCT) and a 75g oral glucose tolerance test (OGTT): (1) controls (n=20), normal responses to both GCT and OGTT; (2) intermediate group (IG) (n=15): false positive GCT, but normal OGTT; and (3) GDM group (n=15), both GCT and OGTT abnormal. IR was assessed by homeostasis model assessment (HOMA-IR) and by insulin resistance index (IRI) based on glycemia and insulinemia during OGTT.

Results. All groups were matched for age and body mass index (BMI). RBP-4 levels (g/ml, meanstandard deviation) were higher in women with GDM vs. controls (53.917.9 vs. 29.713.9, p0.001), with a trend towards higher RBP-4 in GDM compared with IG (38.019.3, p=0.07). There was no significant correlation between RBP-4 and age, BMI, insulin, IRI or HOMA-IR, but there was a moderate, significant negative correlation between RBP-4 and sVCAM-1 (r2=0.20, p=0.001).

Conclusions. RBP-4 levels are elevated in women with GDM, but do not correlate with IR indices and correlate negatively with sVCAM-1. The physiological significance of RBP-4 rise in women with GDM remains to be elucidated.